Town of Winthrop : Record of Deaths 1931, Part 69

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 69

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No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L. as amended.

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

R-301 A

Sollock

(County)

(City or Togn) 39 Johnson are No

St., .. ...... Ward

Horace Howard Brooks

(If deceased is a married, widowed or divorced woman, give also maiden name.)

39 Johnson

St.,

.......... Ward,

(If nonresident, give city or town and state)

days. How long in U. S., if of foreign birth? yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

(write the word)

Single

If less than 1 day Hours Minutes

11 Total time (years)

spent in this

occupation

13 NAME OF

FATHER

Eugene. 8. Barras

100m-9-'30. No. 9954.

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm. AChildrekt

(Signature of Agentof Board of Health or other)

H.O. Sept. 25131,

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH September 25 (Day)

(Month)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from Sept. 1430 19

., to Lept 24 .. , 1931

I last saw him alive on 2 pt24, . 19.5 ...... , death is said

to have occurred on the date stated above, at. 2 ..... " Pm. The principal cause of death and related causes of importance in order of onset were as follows:

Date of Onset

Coronary Throwhours

Contributory causes of importance not related to principal cause:

arteta - sensores;

5 m/s. 5 thyra

Name of operationZe-P

Date of

What test confirmed diagnosis? Chanical Juan's was there an autopsy?

20 Was disease or injury in any way related to occupation of deceased? 200

If so, specify

(Signed)

M. D.

(Address)

78 Washington Due Date Sept 25 1931

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Sub Cuchara Cambridge muy

DATE OF BURIAL

22 NAME OF

UNDERTAKER

Char R Bennem

ADDRESS

Received and filed

Sont. 26, 1931

(Registrar)

f 1

178

Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)

(If U. S. War Veteran, specify WAR) war.

mos.

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent.

PLACE OF DEATH

2 FULL NAME

(a) Residence. No ..

(Usual place of abode)

Length of residence in city or town where death occurred 35 Sts.

3 SEX

4 COLOR OR RACE

Male

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here

3 5-

AGE

Years

Months

Days

8 Trade, profession, or particular

kind of work done, as spinner,

Leather -

sawyer, bookkeeper, etc ..

9 Industry or business in which

work was done, as silk mill,

Saluman

saw mill, bank, etc.

10 Date deceased last worked at

3 years

this occupation (month and

OCCUPATIONI

year) ..

12 BIRTHPLACE (City)

winthrop-

(State or country)

man

14 BIRTHPLACE OF

FATHER (City)

Templeton-

15 MAIDEN NAME

OF MOTHER

Sarah. Whitney

16 BIRTHPLACE OF

PARENTS

MOTHER (City)

(State or country)

M. H.

Informant

(Address)

CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION

is very important. See instructions and extracts from the laws on back of certificate.

Information should be careruny supplied. AGE should be stated EXACTLY. PHYSICIANS should state

(State or country)

mais

(Cemetery)

(City or town)

Revised United States Standard Certificate of Death P

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation. 11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee, " "worker, " "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store," "factory. " 'mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.

Example

The principal cause of death and related causes of importance in order of onset were as follows:

Date of onset

Arteriosclerosis

1015

Chronic interstitial nephritis

I021

Cerebral hemorrhage

July 5, 1927

Contributory causes of importance not related to principal cause:

In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first. second, or third position. "The principal cause in the above example happens to be the second cause given.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a Satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.

.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

M R-305

Essex

(County) Danvers

(City or Town)

No Danvers ... State .... Hospital

St.,

Ward

Danvers (City or town making return)

Registered No. 179

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Adelaide.Nelson

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a)

Residence. No.

(Usual place of abode)

270Bowdoin

.St.,

Ward,

"inthron

(If nonresident, give cily or town and state)

Length of residence in city or town where death occurred

2yrs.

mos.

2days. How long in U. S., if of foreign birth?

yTs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

female

4 COLOR OR RACE

white

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

married

5a If married, widowed, or divorced

HUSBAND of

fGive maiden name of wife in full)

(or) WIFE of

Joseph 0. Nelson

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 AGE 69 Years 4 Months 2 Days

If less than 1 day Hours. .Minutes

OCCUPATION

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

None

9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

10 Date deceased last worked at

this occupation (month and

year)

11 Total time (years) spent in this occupation

12 BIRTHPLACE (City)

Moncton.

(State or country).

N.B.

13 NAME OF

FATHER

Brennan McCormak(Berna

PARENTS

14 BIRTHPLACE OF FATHER (City) (State or country)

Canada

15 MAIDEN NAME

OF MOTHER

Lucinda Blakeney

16 BIRTHPLACE OF MOTHER (City) (State or country)

Canada

17 Gertrude F. Smith, Informant (Address) Hath ne

A TRUE COPY.

ATTEST:

(Registrar of city or town where death occurred) 10/5/31

DATE FILED

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

Sep. 27, 1931

(Month)

(Day)

(Year)

19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)

Cerebral ..... hemorrhage

Arteriosclerosis Died suddenly in bed

20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or Homicide ?

Date of injury 19

Where did injury occur ?

(City or town and State)

Manner of

Nature of

Injury

21 Was disease or injury in any way related to occupation of deceased?

If so, specify.

S ..... Chase Tucker

(Signed)

Prabody

9/28/31 .

M. D.

(Address)

Date

22 PLACE OF BURIAL,

CREMATION OR REMOVALWinthrop

Tinthrop

Sep. (Setery1931. (City or town)

DATE OF BURIAL

23 NAME OF

UNDERTAKER

C. R. Bennisan

ADDRESS

Winthrop, MESS.

Received and filed.

OCT 10 1931

(Registrar of City or Town where deceased resided)

1 1

25m-2-'30. No. 7997-e

PLACE OF DEATH

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH

(If U. S. War Veteran, specify WAR)

(write the word)

--------

Sept. 27, 1931

R-302

PLACE OF DEATH

Middleses (County) A. Readma (City or Town) It.Reading State Som No Richard H- Leet

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

(City or town making return) '

Registered No. 180

(If death occurred in a hospital or institution,

Ward

give its NAME instead of street and number)

2 FULL NAME

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a)

Residence. No ..

3 Wordside Dank

.St.

Ward,

Winthrop

(If nonresident, give city or town and state)

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

mos.

days. How long in U. S., if of foreign birth?

yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

4 COLOR OR RACE

5 SINGLE

MARRIED

WIDOWED

er DIVORCED

(write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

7 AGE

Years

Months

Days

If less than 1 day

Hours

Minutes

8 Trade, profession, or particular

kind of work done, as spinner,

sawyer, bookkeeper, etc ..

9 Industry or business in which

work was done, as silk mill,

. . saw mill, bank, etc ..

10 Date deceased last worked at

this occupation (month and

year)

11 Total time (years)

spent in this

occupation.

12 BIRTHPLACE (City)

Cheloca

(State or country)

mars

13 NAME OF

FATHER

Gung Leet

14 BIRTHPLACE OF

FATHER (City)

E. Boston

(State or country) mars

15 MAIDEN NAME

OF MOTHER

Sadie Barter

16 BIRTHPLACE OF

MOTHER (City)

2. Brotin

(State or country)

17 Hospital Records

Informam .h.Roading State Sanatorium

(Address)

A TRUE COPY.

ATTEST:

Carl C. Mc Cousin Supt.

(Registrar of city or town where death occurred)

1931

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

9 -25

1931, to.

9 - 28

1931

I last saw h

alive on

9 -28

1931, death is said

to have occurred on the date stated above, 1 9.06 mm The principal cause of death and related causes of importance in order of onset were as follows: Dateafonset une Tuberculosis of Limpo

Contributory causes of importance not related to principal cause:

Name of operation

nine

Date of

What test confirmed diagnosis? Kan

Was there an autopsy?

usual sampling

20 Was disease or injury in any way related to occupation of deceased?

If so, specify

S.H. Caron

(Signed)

M. D.

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

Winthrop

DATE OF BURIAL

Get 1

(City or town) 19.31

22 NAME OF

C.A. Rollins

UNDERTAKER

ADDRESS

2. Batin ms

Received and filed

OCT 7 1931

Dantetens of City of Town where deceased resided)

f 1

PARENTS tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION|

important.

50m-2-'30. No. 7997-

DATE FILED 9 - 29

St.,

(If U. S.

War Veteran,

specify WAR)

1931

(Cemetery)

Auchand a. Leet Sept. 28, 19 31

TORM R-301A

N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state

PLACE OF DEATH

Suffolk (Count})

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent. Registered No.

18/

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Asturias

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No. 507 Pleasant

(Usual place of abode)

Length of residence in city or town where death occurred 15 JIS.

.St.,.

Ward,

(If nonresident, give city or town and state)

mes.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

Single

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

Years

Months

2 .Days

If less than 1 day

Hours

Minutes

OCCUPATION!

8 Trade, profession, or particular

kind of work done, as spinner,

sawyer, bookkeeper, etc.

9 Industry or business in which

work was done, as zilk mill,

saw mill, bank, etc.

10 Date deceased last worked at

11 Total time (years)

spent in this

occupation

this occupation (month and

year)

West Singhal

12 BIRTHPLACE (City) ..

(State or country)

13 NAME OF

FATHER

augustus . Leighton

PARENTS

14 BIRTHPLACE OF

FATHER (City)

West Ambok.

(State or country)

15 MAIDEN NAME OF MOTHER

16 BIRTHPLACE OF MOTHER (City) (State or country)

17 Informant ... (Address)

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buffal or transit permit was issued:

Signature of Agent of Board & Health or other) Health Officer 9/30/31

(Official Designation) (Date of Issue of Permit)

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

Sept-

35-

(Month)

(Day)

1731 (Year)

19 I HEREBY CERTIFY, That I attended deceased from

y2-1920

.. , to

19.31.

I fast saw h. k .... alive on.

James?

19.3./, death is said

to have occurred on the date stated above, at 1/130 a.

The principal cause of death and related causes of importance in order of onset were as follows:

Date of Onset

Mdage

arteriosclerosis

01140

Contributory causes of importance not related to principal cause:

Name of operation.

Date of.

What test confirmed diagnosis?

Was there an autopsy: 20

20 Was disease or injury in any way related to occupation of deceased?

If so, specify.

(Signed) Franck D. Manut

. M. D.

(Address) 242 Nach Livs Date : 21931

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

West Pentru

(Cemetery)

(City or town)

DATE OF BURIAL Act × 1st

19.9. 1 ....

2 NAME 0

UNDERTAKER

ADDRESS

Received and filed

COT 2

1931

(Registrar)

(City or Town)

No. 507 Cliquant

... Ward

St .. Leighton - ,

(If U. S. War Veteran, specify WAR)

mos.

days. How long in U. S., if of foreign birth?

yTs.

MARGIN RESERVED FOR BINDING

100m-9-'30. No. 9954.

Uslavia 9. Leighton

Revised United States Standard Certificate of Death Xept . 30, 19 31

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee, " "worker. """ "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store,

"factory, 'mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured, Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Statement of cause of death .- Cause of death means the disease,. or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.

Example

The principal cause of death and related causes of importance in order of onset were as follows:

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Town of Winthrop : Record of Deaths 1931, Part 69

Author: Winthrop (Mass.) Publication date: 1931 Publisher: Number of Pages: 540

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540